The 5 Biggest Outpatient Rehab Billing Mistakes

Outpatient Rehab billing can be complex, but it doesn’t have to be a pain.

1. Entering EOBs Manually

Manual data entry is not only inefficient for staff time, but it can also lead to human errors, such as typos or inverted numbers. This can lead to mistakes in your accounting which can cause claim out of balance rejections and prevent secondary claims from processing normally.

Ask your clearinghouse about electronic options such as Electronic Remittance Advice (ERA) or Electronic Data Interchange (EDI) files. These will significantly reduce the data entry necessary to posting insurance payments, saving you time and headaches.

2. Neglecting Aging

From insurance payments to statement aging, neglecting the aging on your claims can be a significant problem.

This is especially important when it comes to insurance aging issues. Problems here could not only interrupt your cashflow, but you could also miss important timely filing deadlines, hurting your earning potential. It is always a good idea to keep a close eye on the aging of your claims, batch claims regularly, and monitor their status.

If you are dealing with statement aging, you should likely also be concerned with timeliness:  you never want “out of sight, out of mind” to apply to your revenue. Patients are more likely to pay their bills if they are notified of their balance before it is due and your clinic follows up statements regularly.

3. Fee Schedule Issues

Detailed and effective fee schedules are key to ensuring optimized and efficient billing. It’s a good idea to audit and update your fee schedules regularly to accommodate changes to covered codes, new modifiers, and—of course—ensure you are not undercharging for your services.

In addition to updating fee schedules frequently, it’s a good idea to stay affront of allowed and write off amounts within your fee schedules. A well-maintained fee schedule makes monitoring your charge to collection ratio a breeze because you know what to expect. When you know what your payments should look like, it becomes far easier to notice any changes, mistakes, and flag any issues before you see a major interruption in revenue.

4. Mistakes in Intake (Intake Validator, Patient Portal, Visit Check Organizer)

When it comes to effective outpatient rehab billing, prevention is always better than reaction. Having a foolproof intake process can drastically reduce the instances of missing information and prevent billing hassles down the road.

Tools like patient intake portals can empower patients to provide information themselves. Portals may also help patients visualize the information necessary to complete a patient profile.

In the office, you can utilize tools to scrub patient profiles for missing information during intake and again before sending claims to your clearinghouse. For an extra layer of protection, a visit check organizer can to scrub them again on the level of individual visits, on top of in the patient and case information. Your claims are sure to be squeaky clean.

5. Taking Rejections at Face Value

Rejections are always frustrating. You rendered the service and you deserve to get paid! It can be easy to write rejections off as the cost of doing business, however painful that may be. However, if you notice that you are getting many rejections for the same reason, it could be symptomatic of a larger issue.

While it is tedious, it is worthwhile to consider the larger context of your rejections. Are your maps missing information? Are your providers billing restricted code combinations? Are your claims missing the same modifiers over and over? Once you pinpoint the source of your rejections, fixing them and reducing future rejections down the road is well worth the time spent auditing.